By Dr Ananya Mandal, MD
Vertigo is a symptom of an underlying disease. Treatment of the underlying condition often results in treatment of vertigo.
In mild cases symptoms of vertigo may resolve without treatment.
Treatment of Benign paroxysmal positional vertigo
In patients with Benign paroxysmal positional vertigo (BPPV) treatment options include (1, 2) –
- Medications – Drugs used for motion sickness belonging to the class of antihistaminics like Prochlorperazine, Promethazine, Cyclizine or Cinnarizine may help with the nausea and vomiting symptoms.
However, these drugs may not relieve all symptoms of vertigo. It will not prevent vertigo attacks.
- Special exercises may be prescribed for BPPV. Brandt-Daroff exercises are commonly advised for BPPV. These exercises are thought to disperse any fragments that are accumulated in the middle ear.
The exercise involves sitting on the edge of the bed and turning the head 45 degrees to one side. This is followed by lying down quickly on the other side. The patient waits till the vertigo spell stops and sits up.
Exercise on the other side is repeated. Five times on each side for around 10 minutes is advised thrice each day.
- Physicians may also advise the Epley manoeuvre. It has been shown to cure up to 89% of BPPV cases.
The manoeuvre involves performing four different head movements that move the fragments to a place where they cannot cause symptoms.
Each of the positions are held for at least 30 seconds. Around two weeks of the manoeuvre may be needed for complete recovery.
- Home care involves avoidance of head positions that trigger attacks, elevation of head while resting, getting up and sitting down slowly and avoidance of driving.
Treatment of vertigo
Specific management of vertigo includes (1-4):
- During an attack the patient is asked to lie still in a quiet, darkened room. Stressful situations should be avoided. Anxiety can make the symptoms worse.
- In cases of labyrinthitis infection is caused by viruses. When the infections are due to bacterial causes, antibiotics may be prescribed. Steroids may be advised to reduce inflammation.
- For patients with vestibular neuritis or vestibular neuronitis the viral infection usually needs no therapy. Bed rest is advised till the infection subsides. Vestibular rehabilitation may be advised. Steroids may be advised to reduce inflammation.
- For Ménière’s disease there are a number of treatment options. Patient is advised low salt diet, medication for treating the disease and preventing attacks.
Betahistine is a medicine that can help to prevent vertigo caused by Ménière's disease.
For tinnitus or ringing of the ears sound therapy is advised. Hearing aids may be prescribed for hearing loss. Some patients need physiotherapy to deal with balance problems. Surgery may be required in some patients.
- Separate management of symptoms of stress, anxiety and depression associated with vertigo is important.
- Vertigo due to disease of the central nervous system need treatment of the underlying disease rather than the symptom of vertigo alone. Those with stroke, brain tumors or severe migraine may need to be admitted and treated by specialists and neurologists.
Edited by April Cashin-Garbutt, BA Hons (Cantab)
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